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Cost-Sharing Evidence Important to Establish Outcome Effects –No Insurance (Full Cost to Patient) Is Associated With Decreased Use of Medical Care and Worse Clinical Outcomes –RAND HIE Showed ED Cost-sharing (Partial Cost to Patient) Is Associated With a Reduction in Use of Emergency Care in General Population; No Apparent Outcome Effect –Entire ED Effect Within Lacerations on Non-Sutured Lacerations Comparison with the RAND HIE Results –Cost-Sharing the Same for ED and Office Visits –Did Not Sample Among Elderly –Did Not Study Cost Sharing In Managed Care Settings –Small Sample Meant Did Not Establish Effect on Mortality

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Conclusions In This Population of Patients in a Prepaid, Integrated Delivery System: Having to Pay a Portion of ED Costs Reduced ED visits, and by Roughly the Same Amount as in the RAND HIE There was No Evidence of Clinical Harm Associated with Having to Pay Higher ED Costs, i.e. Higher Cost-Sharing Did Not Result in More Hospitalizations or Deaths.